目的 观察比较巨细胞病毒(CMV)肝炎婴儿停哺乳与继续母乳喂养后临床及实验室指标的异同,为临床巨细胞病毒肝炎婴儿确定合理的治疗方案并提供有力的理论依据.方法 87例非淤胆型巨细胞病毒肝炎婴儿为研究对象,发病年龄均<6个月.根据母乳CMV-IgM阳性,随机分成2组:哺母乳组54例,停母乳组33例;2组均给予更昔洛韦诱导缓解、巩固维持、保肝退黄、调节免疫等治疗.治疗前及治疗3个月、6个月、1年分别应用免疫荧光法检测血清CMVpp65抗原;荧光定量聚合酶链反应(FQ-PCR)法检测尿CMV DNA;放射免疫法检测血清CMV-IgM;赖氏比色法、匀相测定法、溴甲酚绿法、改良J-G法等检测肝功能.结果 治疗前及治疗后3个月、6个月,2组巨细胞病毒肝炎婴儿肝功能、HCMVpp65抗原阳性率和CMV-IgM阳性率及尿CMVDNA阳性率相比差异无统计学意义(P>0.05);与治疗前相比,治疗后3个月2组婴儿肝功能、HCMVpp65抗原阳性率及CMV-IgM阳性率差异均有统计学意义(P<0.05),尿CMVDNA阳性率与治疗前相比差异无显著性(P>0.05);治疗6个月后与治疗前及治疗3个月相比各指标差异均有统计学意义(P<0.05);随访1年时检测2组患儿肝功能差异无统计学意义(P>0.05).结论 非淤胆型巨细胞病毒肝炎婴儿,无需停哺母乳.

目的 观察比较更昔洛韦单一诱导与诱导并维持治疗非淤胆型婴儿巨细胞病毒(CMV)肝炎的疗效差别,为临床婴儿CMV肝炎确定合理治疗方案提供有力的理论依据.方法 87例非淤胆型CMV肝炎患儿为研究对象,发病年龄＜6月.随机分成2组:A与B组.A组50例惠儿予更昔洛韦诱导治疗2周+维持4疗程；B组37例患儿仅予更昔洛韦诱导无维持治疗；两组均同时给予保肝、调节免疫等一般治疗至6个月,随访时间1年.治疗前及治疗3个月、6个月分别应用免疫荧光法检测两组惠儿外周血单个核细胞HCMVpp65抗原；荧光定量聚合酶链反应(FQ-PCR)法检测尿CMVDNA；放射免疫法检测血清CMV-IgM；赖氏比色法检测肝功能.随访1年结束时仅检测两组惠儿肝功能水平.结果 治疗前、治疗3个月及治疗6个月两组患儿肝功能、HCMVpp65抗原阳性率和CMV-IgM阳性率及尿CMVDNA阳性率相比分别无显著性差异P＞0.05；治疗3个月与治疗前相比,两组患儿肝功能、HCMVpp65抗原阳性率及CMV-IgM阳性率均有显著性差异,P＜0.05,而尿CMVDNA阳性率无显著性差异,P＞0.05;治疗6个月与治疗前相比,两组惠儿肝功能、HCMVpp65抗原阳性率、CMV-IgM阳性率及尿CMVDNA阳性率均无显著性差异,P＞0.05,与治疗3个月相比有显著性差异,P＜0.05;随访1年时检测两组肝功能无显著性差异,P ＞0.05.结论 更昔洛韦治疗婴儿非淤胆型CMV肝炎,仅用诱导治疗,无需维持治疗,亦可达到较好疗效.

肺炎是一种严重危害儿童健康的常见病,多发病。重症肺炎目前仍是5岁以下儿童死亡主要病因之一。细菌、病毒及支原体等病原体感染是引起肺炎的主要原因,但在儿童由于痰液采集困难及肺穿刺受限制,病原学确诊有一定难度,寻找一种简单、

目的观察高压氧(HBO)综合治疗对小儿外伤性脑梗死的临床疗效。方法将62例外伤性脑梗死患儿随机分为治疗组(41例)和对照组(21例),进行对比观察。治疗组在综合治疗基础上加用HBO治疗,采用单人仓或多人仓氧气加压给氧,每天1次,10天为1个疗程。结果HBO治疗组总有效率92.68%,对照组有效率80.95%,2组有显著性差异(P<0.05);治疗组治疗后患儿惊厥持续时间及昏迷持续时间显著短于对照组(P<0.01)。HBO治疗开始时间在发病5天以内的患儿疗效优于治疗开始时间在发病5天以后的患儿(P<0.05)。结论HBO综合治疗小儿外伤性脑梗死疗效优于单纯药物治疗,且治疗越早疗效及预后越好。

目的了解婴幼儿支气管肺炎(肺炎)并心力衰竭(心衰)时血清心肌酶及多项生化指标的改变,以便在诊治过程中采取综合措施。方法选择本院儿科住院肺炎患儿共160例,其中轻症肺炎82例,重症肺炎并心衰(肺炎心衰)30例,先天性心脏病并肺炎心衰(先心肺炎心衰)48例。另选22例健康儿童作为对照组。采用O-lympus2700全自动生化分析仪,测定肺炎患儿急性期、恢复期及对照儿童血清多项生化指标。结果肺炎患儿心肌酶和尿素氮水平增高,而K+、Na+、Cl-、TCa2+、二氧化碳结合力水平下降。先心肺炎心衰组、肺炎心衰组、轻症肺炎组与对照组比较均有明显差异(P<0.01),前3组之间两两比较亦有一定差异(P<0.01);急性期与恢复期测定结果比较,心肌酶及各项生化指标趋向正常水平。结论婴幼儿肺炎血清心肌酶及多项生化指标均有不同程度改变,病情越重,心衰程度越重,改变越明显。及时检查、及时发现、积极纠正,可以减少并发症发生,提高重症肺炎患儿抢救成功率、降低病死率。

继发性先天性肾病综合征（CNS）是指出生后3个月内起病的肾病综合征（NS）。其中分为典型的芬兰型先天性肾病综合征（特发性）及新生儿感染等因素所致的先天性肾病综合征（获得性）。后者国内外报道的有先天性梅毒伴NS、先天性弓形虫伴 NS、先天性风疹伴 NS 等,继发于人CMV 感染的 CNS 国内报道较少。现将我院收治的2例CMV 感染致 CNS 报道如下。

Objective To investigate the roles of adrenomedullin(ADM) and endothelin-1(ET-1) in left-to-right shunt congenital heart disease(CHD) complicated with congestive heart failure(CHF).Methods Plasma ADM and ET-1 concentrations were measured by radioimmunoassay in heart failure stage and recovery period of 18 infants with left-to-right shunt CHD.Also 20 healthy infants acted as control group were measured.Results Plasma concentrations of ADM and EF-1 were significantly higher in heart failure stage of left-to-right CHD infants than those in their recovery period,and both in their heart failure stage and in their recovery period were higher than that in control group(P0.01 or 0.02).Conclusion Both ADM and ET-1 may play important roles in the pathophysiology of CHF secondary to left-to-right shunt CHD.

目的探讨婴儿巨细胞病毒肺炎的临床特点及有关实验室检查.方法回顾性分析婴儿巨细胞病毒肺炎的临床资料.结果临床表现不典型,或以其他器官损害表现或以相关疾病的症状为主诉.尿萤光定量聚合酶链反应均阳性,胸部X线片有阳性改变.更昔洛韦治疗,治愈17例.结论婴儿巨细胞病毒肺炎的临床表现不典型,易误诊、漏诊.荧光定量聚合酶链反应检测尿液中巨细胞病毒简单易行,且具有高灵敏、高准确性、高特异性.更昔洛韦疗效好.

Objective To investigate the cause and the clinical symptoms of the outbreak of aseptic meningitis having occurred in Xuzhou district from May to August, 2001.?Methods The medical files were reviewed and a standard questionnaire was filled according to the conditions of the 262 suspected in-patients. Viral FQ-PCR for Coxsachie viruses B, ECHO virus, encephalitis B virus and adenoviruses were performed on cerebrospinal fluid. Indirect immunofluorescence assays were concurrently made on sera.?Results Coxsachie virus B was positive in 52% (39/75) cerebrospinal fluid specimens and in 69.8% of 254 serum samples. The clinical picture and laboratory findings were typical of viral meningitis: aged 28 days to 14 years, with 90% around 3 years, headache present in 20%, photophobia in 10%, vomiting in 40%, fever in 80%, neck stiffness in 36 8%. 10% of the patients had seizures, and 84.5% had abnormal EEG. Only one death occured in the series.?Conclusion Coxsachie virus B was the main cause of the outbreak of aseptic meningitis, possibly through respiratory transmission.

目的探讨可溶性细胞间黏附分子-1(sICAM-1)、血清白细胞介素-5(sIL-5)在毛细支气管炎中的作用。方法采用ELISA法测定30例急性呼吸道合胞病毒(RSV)毛细支气管炎(毛支)患儿sICAM-1和sIL-5浓度，并与20例正常婴儿对照比较。结果RSV毛支患儿sICAM-1、sIL-5浓度较对照组明显升高(P均＜0.01)。结论sICAM-1、sIL-5参与婴儿RSV毛支的免疫病理过程。

Objective To search into the changes and significance of eosinophil cationic protein (ECP) and immunoglobulin E (IgE) in infants with asthmatic bronchitis. Methods Serum ECP and IgE concentrations were measured with Pharmacia UniCAP system in 18 infants with asthmatic bronchitis and 30 infants with asthma and 15 healthy controls. Results Serum ECP and IgE concentrations were significantly higher in asthmatic bronchitis and asthma infants than in controls, but no difference was found between asthmatic bronchitis infants and asthma infants. Conclusion The results that asthmatic bronchitis is similar to asthma in eosinophil activation and IgE production suggest that asthmatic bronchitis is correlated with asthma.

本文对14例儿童类风湿性关节炎(JRA)患儿多脏器损害的临床资料进行分析总结，以了解JRA多脏器损害的临床特点，改善预后。 临床资料 一、一般资料 1993年1月～1999年11月我科收治JRA患儿97例，其中多脏器受损14例，均为全身型JRA。14例中男9例，女5例，年龄6～13 a；病程6个月～8 a；首次发病年龄≤2 a 4例，5～9 a 10例，最小1例为2个月始即有不规则发热。10例反复发作3次以上。两个脏器损害6例，3个以上脏器损害8例。

目的探讨内皮素(ET1)、血栓烷(TXA2)和前列环素(PGI2)在小儿中枢神经系统感染(FCNS)中的意义.方法采用放射免疫方法检测FCNS儿脑脊液(CSF)中ET1及TXA2和PGI2的稳定代谢产物TXB2和6-k-PGF1α,非感染手术儿CSF为对照.结果FCNS儿CSF、ET1、TXB2及TXB2/6-k-PGF1α(T/K)比值升高,昏迷儿CSF、ET1、TXB2高于非昏迷儿,恢复期CSF、ET1、TXB2/6-k-PGF1α.比值较急性期下降.结论FCNS时神经系统ET1和TXA2生成增加,CSF中ET1、TXD2和6-k-PGF1.改变可反映脑实质损伤程度,有助于临床病情判断.